AIM GLOBAL PROSPET APPLICATION FORM

SURNAME *

FIRST NAME *

MIDDLE NAME

PHONE NO.

EMAIL *

DATE OF BIRTH *

MM

/

DD

/

YYYY

ADDRESS *

HOW DID YOU HEAR ABOUT ALLIANCE IN MOTION GLOBAL? *

WILL YOU LIKE TO BECOME A RETAILER OR BUSINESS DEVELOPER?

WHAT PACKAGE ARE YOU INTERESTED IN? PLEASE PICK OPTIONS BELOW

Global Starter Package = N36,000 or $181 (1 HEAD ACCOUNT)

Entrepreneur Package = N108,000 or $543 (3 HEADS ACCOUNT)

International Business = N252,000 or $1267 (7 HEADS ACCOUNT)

Clear selection